Complex speech-language therapy interventions for stroke-related aphasia: the RELEASE study incorporating a systematic review and individual participant data network meta-analysis

Autor:	Brady MC; Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK, Ali M; Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK, VandenBerg K; Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK, Williams LJ; The Usher Institute, University of Edinburgh, Edinburgh, UK, Williams LR; Nursing Midwifery and Allied Health Professions Unit, Glasgow Caledonian University, Glasgow, UK, Abo M; Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan, Becker F; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway, Bowen A; Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK, Brandenburg C; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia, Breitenstein C; Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany, Bruehl S; St Mauritius Rehabilitation Centre, Meerbusch, Germany; Clinical and Cognitive Neurosciences, Department of Neurology, Medical Faculty, RWTH Aachen University, Aachen, Germany; Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK, Copland DA; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia, Cranfill TB; Special Education, Eastern Kentucky University, Richmond, KY, USA, di Pietro-Bachmann M; Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Geneva, Switzerland, Enderby P; School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK, Fillingham J; Nursing Directorate, NHS Improvement, London, UK, Galli FL; Neurorehabilitation Clinic, Neurological Sciences Department, Marche Polytechnic University, Ospedali Riuniti di Ancona, Ancona, Italy, Gandolfi M; Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy, Glize B; EA 4136 Handicap Activity Cognition Health, University of Bordeaux, Bordeaux, France; Department of Physical Medicine and Rehabilitation, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France, Godecke E; School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia, Hawkins N; Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK, Hilari K; Division of Language and Communication Science, City, University of London, London, UK, Hinckley J; Nova Southeastern University, Fort Lauderdale, FL, USA, Horton S; School of Health Sciences, University of East Anglia, Norwich, UK, Howard D; School of Education Communication and Language Sciences, Newcastle University, Newcastle Upon Tyne, UK, Jaecks P; Faculty of Linguistics and Literary Studies, Bielefeld University, Bielefeld, Germany, Jefferies E; Department of Psychology, University of York, York, UK, Jesus LMT; School of Health Sciences (ESSUA) and Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal, Kambanaros M; Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus, Kang EK; Department of Rehabilitation Medicine, Kangwon National University Hospital, Gangwon-do, Republic of Korea, Khedr EM; Department of Neurology, Assiut University Hospital, Assiut, Egypt, Kong APH; School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA, Kukkonen T; Ear, Nose and Throat (ENT)/Department of Phoniatry, Tampere University Hospital, Tampere, Finland, Laganaro M; Faculty of Psychology and Educational Science, University of Geneva, Geneva, Switzerland, Lambon Ralph MA; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK, Laska AC; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden, Leemann B; Neurorééducation, Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève, Geneva, Switzerland, Leff AP; Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK, Lima RR; Department of Speech Language Pathology, Educational Association Bom Jesus – IELUSC, Santa Catarina, Brazil, Lorenz A; Institut für Psychologie, Humboldt University Berlin, Berlin, Germany, MacWhinney B; Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA, Shisler Marshall R; Department of Communication Sciences and Special Education, University of Georgia, Athens, GA, USA, Mattioli F; Neuropsychology Unit, Azienda Socio Sanitaria Territoriale (ASST), Brescia via Nikolajewka 13, Italy, Maviş İ; Department of Speech and Language Therapy, Anadolu University, Eskişehir, Turkey, Meinzer M; UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia, Nilipour R; Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran, Noé E; NEURORHB-Hospitales Vithas, Valencia, Spain, Paik NJ; Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea, Palmer R; School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK, Papathanasiou I; Department of Speech and Language Therapy, Technological Educational Institute of Western Greece, Patras, Greece, Patrício BF; Speech Therapy Department of Health School of Polytechnic Institute of Porto, Porto, Portugal, Martins IP; Laboratório de Estudos de Linguagem, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal, Price C; Wellcome Centre for Human Neuroimaging, University College London, London, UK, Jakovac TP; Department of Speech and Language Pathology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia, Rochon E; Department of Speech–Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada, Rose ML; School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, VIC, Australia, Rosso C; Institut du Cerveau (Paris Brain Institute), Sorbonne Université, ICM, Inserm, CNRS, AP-HP, Hôpital Salpetriere, Stroke Unit, DMU Neuroscience 6, Paris, France, Rubi-Fessen I; RehaNova Rehabilitation Hospital and Department of Special Education and Rehabilitation, University of Cologne, Cologne, Germany, Ruiter MB; Sint Maartenskliniek, Rehabilitation Centre and Centre for Language Studies, Radboud University, Nijmegen, the Netherlands, Snell C; Warrington Hospital, Warrington and Halton NHS Foundation Trust, Warrington, UK, Stahl B; Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany, Szaflarski JP; UAB Epilepsy Centre, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA, Thomas SA; Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK, van de Sandt-Koenderman M; Rijndam Rehabilitation, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands, van der Meulen I; Rijndam Rehabilitation, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands, Visch-Brink E; Department of Neurology and Neurosurgery, Erasmus University Medical Center, Rotterdam, the Netherlands, Worrall L; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia, Wright HH; College of Allied Health Sciences, East Carolina University, Greenville, SC, USA
Jazyk:	angličtina
Zdroj:	2022 Sep.
DOI:	10.3310/RTLH7522
Abstrakt:	Background: People with language problems following stroke (aphasia) benefit from speech and language therapy. Optimising speech and language therapy for aphasia recovery is a research priority. Objectives: The objectives were to explore patterns and predictors of language and communication recovery, optimum speech and language therapy intervention provision, and whether or not effectiveness varies by participant subgroup or language domain. Design: This research comprised a systematic review, a meta-analysis and a network meta-analysis of individual participant data. Setting: Participant data were collected in research and clinical settings. Interventions: The intervention under investigation was speech and language therapy for aphasia after stroke. Main Outcome Measures: The main outcome measures were absolute changes in language scores from baseline on overall language ability, auditory comprehension, spoken language, reading comprehension, writing and functional communication. Data Sources and Participants: Electronic databases were systematically searched, including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Linguistic and Language Behavior Abstracts and SpeechBITE (searched from inception to 2015). The results were screened for eligibility, and published and unpublished data sets (randomised controlled trials, non-randomised controlled trials, cohort studies, case series, registries) with at least 10 individual participant data reporting aphasia duration and severity were identified. Existing collaborators and primary researchers named in identified records were invited to contribute electronic data sets. Individual participant data in the public domain were extracted. Review Methods: Data on demographics, speech and language therapy interventions, outcomes and quality criteria were independently extracted by two reviewers, or available as individual participant data data sets. Meta-analysis and network meta-analysis were used to generate hypotheses. Results: We retrieved 5928 individual participant data from 174 data sets across 28 countries, comprising 75 electronic (3940 individual participant data), 47 randomised controlled trial (1778 individual participant data) and 91 speech and language therapy intervention (2746 individual participant data) data sets. The median participant age was 63 years (interquartile range 53–72 years). We identified 53 unavailable, but potentially eligible, randomised controlled trials (46 of these appeared to include speech and language therapy). Relevant individual participant data were filtered into each analysis. Statistically significant predictors of recovery included age (functional communication, individual participant data: 532, n  = 14 randomised controlled trials) and sex (overall language ability, individual participant data: 482, n  = 11 randomised controlled trials; functional communication, individual participant data: 532, n  = 14 randomised controlled trials). Older age and being a longer time since aphasia onset predicted poorer recovery. A negative relationship between baseline severity score and change from baseline ( p  < 0.0001) may reflect the reduced improvement possible from high baseline scores. The frequency, duration, intensity and dosage of speech and language therapy were variously associated with auditory comprehension, naming and functional communication recovery. There were insufficient data to examine spontaneous recovery. The greatest overall gains in language ability [14.95 points (95% confidence interval 8.7 to 21.2 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.78 points (95% confidence interval 0.48 to 1.1 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with receiving speech and language therapy 4 to 5 days weekly; for auditory comprehension [5.86 points (95% confidence interval 1.6 to 10.0 points) on the Aachen Aphasia Test-Token Test], the greatest gains were associated with receiving speech and language therapy 3 to 4 days weekly. The greatest overall gains in language ability [15.9 points (95% confidence interval 8.0 to 23.6 points) on the Western Aphasia Battery-Aphasia Quotient] and functional communication [0.77 points (95% confidence interval 0.36 to 1.2 points) on the Aachen Aphasia Test-Spontaneous Communication] were associated with speech and language therapy participation from 2 to 4 (and more than 9) hours weekly, whereas the highest auditory comprehension gains [7.3 points (95% confidence interval 4.1 to 10.5 points) on the Aachen Aphasia Test-Token Test] were associated with speech and language therapy participation in excess of 9 hours weekly (with similar gains notes for 4 hours weekly). While clinically similar gains were made alongside different speech and language therapy intensities, the greatest overall gains in language ability [18.37 points (95% confidence interval 10.58 to 26.16 points) on the Western Aphasia Battery-Aphasia Quotient] and auditory comprehension [5.23 points (95% confidence interval 1.51 to 8.95 points) on the Aachen Aphasia Test-Token Test] were associated with 20–50 hours of speech and language therapy. Network meta-analyses on naming and the duration of speech and language therapy interventions across language outcomes were unstable. Relative variance was acceptable (< 30%). Subgroups may benefit from specific interventions. Limitations: Data sets were graded as being at a low risk of bias but were predominantly based on highly selected research participants, assessments and interventions, thereby limiting generalisability. Conclusions: Frequency, intensity and dosage were associated with language gains from baseline, but varied by domain and subgroup. Future Work: These exploratory findings require confirmatory study designs to test the hypotheses generated and to develop more tailored speech and language therapy interventions. Study Registration: This study is registered as PROSPERO CRD42018110947. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research ; Vol. 10, No. 28. See the NIHR Journals Library website for further project information. Funding was also provided by The Tavistock Trust for Aphasia. (Copyright © King’s Printer and Controller of HMSO 2022. This work was produced by Brady et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.)
Databáze:	MEDLINE
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